Why are eye injuries serious?

Most eye injuries are minor and heal quickly with appropriate treatment, without causing any long-term loss of vision. However, some eye injuries can be very serious, leading to permanent vision loss or ongoing pain and discomfort.

Eye injuries are the major cause of blindness in one eye and are much more common in men, particularly of working age, than women.

Fortunately, there are safety precautions you can take to help prevent eye injuries.

Anatomy of the eye.  

There are many types of eye injuries, but most fall into one of five categories: lacerations and abrasions, foreign bodies, blunt injuries, chemical injuries and light-related injuries.

Lacerations and abrasions

Lacerations (cuts) and abrasions (scratches) can affect the front sections of the eye, including the cornea, conjunctiva and sclera, as well as the eyelids.

They can occur for a variety of reasons, including:

  • A blow to the eye (including being hit by a branch or a flying object);
  • Sand or dust in windy environments, and;
  • Contact lens wear.

The front section of the eye, particularly the cornea, is very sensitive to damage, so lacerations and abrasions can cause pain and irritation, particularly when blinking, as well as redness, watering and sensitivity to light.

Most superficial damage to the eye will heal by itself within a few days. However, it can increase the risk of infection. If the cornea in particular becomes affected, this can lead to scarring and vision loss. This risk is increased with injuries caused by contact lenses, or if the eye is contaminated with soil or plant matter such as leaves or branches.

Lacerations can also penetrate the surface layers of the eye. These injuries are far more serious, as they can damage the structures inside the eye and cause infection, leading to permanent vision loss. In more severe cases, fluid from inside the eye can leak out and the eye may begin to lose its shape.

It is important to remember that a laceration that penetrates the eye may not be any more painful than a more superficial wound.

Lacerations can also damage the eyelids, which are vital for protecting the eye. Lacerations that affect the tear ducts - the small channels located in the inner corners of the upper and lower eyelids that drain tears away from the eye - can lead to a constantly watering eye.

Surgery may be required to repair more serious lacerations of the eyelids and eyeball. In very severe cases where repair is not an option, the eye may need to be removed.

Antibiotics or, less commonly, other drugs such as antifungal medications, may be recommended to prevent or treat any signs of infection.

Antibiotics can be administered as eye drops.Eye drops are an effective way of directly administering eye medication.  

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Antifungal

A medication that kills fungi or inhibits their growth.

Cornea

The clear, dome-shaped structure at the front of the eye. It sits in front of the iris and pupil and helps to focus light onto the retina at the back of the eye.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Conjunctiva

The transparent lining that covers the front of the eye and inside of the eyelids.

Sclera

The tough outer layer of the eye, commonly known as the 'white' of the eye.

Lens

A transparent part of the eye that helps to focus light at the back of the eye.

Foreign bodies

A foreign body is any object that becomes stuck in the eye. In mild cases, it may simply become caught between one of the eyelids and the front surface of the eye, or it may lodge in one of the surfaces of the eye. In severe cases, foreign bodies can penetrate into the interior of the eye.

Foreign bodies can include:

  • Detached eyelashes;
  • Displaced or torn contact lenses;
  • Dust, pollen and other matter circulating in the air;
  • Molten metal from welding, and;
  • Much larger objects such as nails from hammering and using nail guns.

Foreign bodies can cause symptoms similar to lacerations and abrasions, such as pain and irritation (particularly when blinking), redness, watering and sensitivity to light. Depending on their location, size and the damage they do to the structures of the eye, they may lead to permanent vision loss. In very severe cases, the eye may not be able to be repaired and will need to be removed.

Treatment involves removing the foreign body. For superficial foreign bodies, anaesthetic drops can be put into the eye to reduce discomfort and make it easier for the foreign body to be removed. For foreign bodies that penetrate inside the eye, surgery under sedation or general anaesthetic may be required. Antibiotics may be recommended to prevent or treat infection.

Anaesthetic

A medication or other substance that causes a temporary loss of sensations, including pain.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

General anaesthetic

An anaesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anaesthetic is given in hospital by a specialist called an anaesthetist.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Blunt injuries

A blunt impact to the eye, such as a blow, or being hit by an object such as a ball, can cause a range of eye injuries.

While some injuries are relatively minor, it may not be immediately obvious how severely the eye is injured; some symptoms may not become apparent for hours or days. For this reason, if a blunt impact occurs to the eye or the upper face, it is important to get the injury assessed as soon as possible.

Black eye

A black eye occurs when blood accumulates in the skin of the eyelids and surrounding skin, causing swelling and bruising. A black eye is a relatively minor injury that will go away without treatment over days or weeks.

Regularly using cold followed by warm compresses in the first two days can help reduce the bruising and swelling. Mild pain-relief medications such as ibuprofen and paracetamol can help to manage the pain.

Subconjunctival haemorrhage

A subconjunctival haemorrhage occurs when blood pools between the conjunctiva and the sclera. Because the conjunctiva is clear, the surface of the eye may appear bright red.

Like a black eye, a subconjunctival haemorrhage is usually a minor injury and can even sometimes occur due to a bout of vomiting or coughing. It will generally go away within a couple of weeks without treatment. If it occurs spontaneously, your doctor may recommend checking your blood pressure to make sure that hypertension is not causing the bleeding.

Bleeding inside the eye

Blunt impacts can lead to bleeding inside the eye. It may occur:

  • In the front part of the eye and be visible in front of the pupil or iris. This is called a hyphema, or;
  • In the back part of the eye, behind the iris, in which case it is called a vitreous haemorrhage and will not be visible.

Bleeding inside the eye may blur or block vision. While the blood may gradually resolve without treatment, it can lead to permanent vision loss, so it requires immediate assessment. Bleeding can also lead to increased pressure inside the eye, potentially causing glaucoma and permanent damage to the optic nerve at the back of the eye. In some cases, surgery may be required to remove blood from inside the eye.

Damage to internal structures of the eye

Blunt impacts can damage a number of structures inside the eye, including:

  • The iris, which may be torn;
  • The lens, which may detach from the ligaments that hold it in place and become dislocated backwards inside the eye, and;
  • The retina, which may be torn and detached from the back of the eye. This is known as retinal detachment.

These injuries can lead to significant and permanent vision loss, and require immediate assessment and prompt treatment. In the case of retinal detachment, reattachment surgery may be required. For a dislocated lens, surgical replacement of the damaged lens with an implant (called an intraocular lens) may be necessary.

Blunt trauma may also cause inflammation to develop inside the eye in the days after the injury. This may cause permanent damage inside the eye and require treatment, often with eye drops containing steroids such as prednisolone to reduce the inflammation.

Blunt impact to the eye can cause internal damage, such as retinal detachment.A blunt impact to the eye can cause internal damage, such as retinal detachment.  

Orbital injuries

Severe blows to the face can lead to fractures of the orbits, the bony cavities in the skull in which the eyeballs sit. This can lead to pain and swelling around the eye and decreased vision.

In some cases, particularly if the fracture occurs in the bottom wall of the orbit, a hole can open up between the orbit and the sinuses in the bones. This is known as a blowout fracture. It can cause the eyeball and muscles to move out of place, causing double vision. Double vision can also occur if a muscle is caught in the fracture.

Orbital fractures require immediate assessment. Surgical repair of the damaged bone or muscles may be necessary.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Retina

The light-sensitive layer of tissue that lines the inside of the back of the eye. As part of the process of vision, cells in the retina send neural signals along the optic nerve to the brain.

Sinuses

A cavity within bone or other bodily tissue. Often refers to the hollow cavities within the facial bones on either side of the nose that filter the air that is breathed in through the nose.

Steroids

A class of chemical substances that have a certain complex of carbon particles. The body produces several types of steroids naturally and artificially-produced steroids are used as medications.

Conjunctiva

The transparent lining that covers the front of the eye and inside of the eyelids.

Iris

A coloured, disc-shaped membrane located in the front of the eye, which controls the size of the pupil, to help focus light at the back of the eye.

Sclera

The tough outer layer of the eye, commonly known as the 'white' of the eye.

Pupil

The dark opening in the front of the eye, which can change its size in response to light.

Optic nerve

One of the pair of nerves that transmit visual images from the eye to the brain.

Lens

A transparent part of the eye that helps to focus light at the back of the eye.

Chemical injuries

While many chemicals can irritate the eye, chemicals that are acidic or alkali can lead to serious burns that can cause extensive scarring, vision loss and, in some cases, loss of the eye.

Chemicals may enter the eye via splashes of fluid, or in powdered form distributed through the air. Particularly dangerous chemicals include:

  • Acids, such as the acid found in car batteries, bleach, vinegar and other acids used in workplaces, and;
  • Alkalis, such as drain cleaners, cement, cleaning products containing ammonia and fertilisers.

Chemical burns are medical emergencies. Call 000 for an ambulance. Chemical burn injuries tend to be very painful and the natural response is to close your eyes, but this can trap the substance against the eye and make the damage worse. First aid is very important. In order to minimise damage to the eye, it must be opened and flushed with sterile saline or, if this is not available, water, as soon as possible, until the chemical is diluted. This can take from 30 minutes up to two hours for some strong acids and alkalis.

Further treatment may be needed to promote healing, reduce the risk of infection and inflammation and control the pain caused by the burn. Surgery may be recommended to help repair the damage done to the surface of the eye. In some cases, a cornea transplant may be recommended. If the damage is very severe, it may be necessary to remove the eye.

Cornea

The clear, dome-shaped structure at the front of the eye. It sits in front of the iris and pupil and helps to focus light onto the retina at the back of the eye.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Inflammation

A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.

Light-related injuries

While your eyes are designed to be exposed to light, exposing them to too much light can lead to damage.

Ultraviolet keratitis

Ultraviolet (UV) light can damage the structures of the eye in a similar way that it can cause sunburn of the skin. When the cornea is exposed to too much UV light, this can cause a condition called ultraviolet keratitis.

Situations that can involve high levels of UV light include:

  • Being exposed to a lot of sunlight, particularly in places where there are a lot of reflective surfaces, such as water and snow. The risk can be greater at higher altitudes where, due to the thinner atmosphere, the UV light can be stronger;
  • Tanning beds and booths that use UV light to stimulate tanning of the skin, and;
  • Using arc welders, which emit high levels of UV light.

Symptoms may not develop until hours after exposure and can include pain, feeling like you have a foreign body in your eye, and sensitivity to light. The cornea will generally repair itself over a few days, but it can be very uncomfortable. Treatment can include using lubricating drops and ointments, wearing sunglasses and taking mild pain-relief medications such as ibuprofen and paracetamol.

Anaesthetic drops are generally not given to help with pain because they can slow the healing process.

Solar retinopathy

The retina, the light-sensitive layer of tissue at the back of the eye, is very delicate, particularly the central area that is responsible for fine-detailed vision, such as that used when you read.

Staring at the sun for too long can cause heat to build up in the central retina and lead to irreversible damage. This is called solar retinopathy and a person with this condition does not become completely blind, but may have permanent problems with reading and seeing other people's faces.

Situations in which people may stare for too long at the sun can include watching solar eclipses. For this reason, it is recommended that you never look directly at the sun or an eclipse.

Anaesthetic

A medication or other substance that causes a temporary loss of sensations, including pain.

Cornea

The clear, dome-shaped structure at the front of the eye. It sits in front of the iris and pupil and helps to focus light onto the retina at the back of the eye.

Retina

The light-sensitive layer of tissue that lines the inside of the back of the eye. As part of the process of vision, cells in the retina send neural signals along the optic nerve to the brain.

Ultraviolet

A type of invisible radiation found in sunlight. Ultraviolet radiation has both beneficial and harmful effects on the body. Exposure to it is a major risk factor for sunburn and skin cancer.

Situations that can increase the risk of eye injuries

There are some situations in which the risks of eye injuries are higher than usual.

Some of the following occupational activities can be associated with an increased risk of eye injuries:

  • Working in dusty environments;
  • Handling chemicals;
  • Using tools that emit compressed air;
  • Using machines and tools with sharp or cutting edges;
  • Using drills or hammering;
  • Welding, and;
  • Spraying.

It is also important to remember that if you are doing these activities at home, the risk of eye injuries increases for other people who may be in the area.

Some sports can also increase the risk of serious eye injury. Beginners may be at greater risk of injuries because they are still learning how to play the sport well and safely.

Higher-risk sports can include those:

  • That involve small projectiles moving at high speeds, such as paintball and air-rifle shooting;
  • With hard, smaller balls or projectiles, such as badminton and squash;
  • That involve bats, sticks or long, sharp equipment, such as fencing, hockey, cricket and lacrosse and;
  • That can involve people's fingers coming into close contact with other people's faces, such as basketball. 

Signs and symptoms

Different eye injuries will produce different signs and symptoms. Some of these have been covered in the sections above.

In general, signs and symptoms of eye injuries can include:

  • Pain or irritation in the eye;
  • Redness of the eye;
  • Persistent watering of the eye;
  • Sensitivity to light;
  • Sudden blurring of vision or loss of vision, and;
  • Sudden appearance of double vision.

Dealing with an eye injury

When an eye injury occurs, it will often not be clear what kind of damage has occurred and how severe it is, as some symptoms may not become apparent for some time.

However, early treatment is most effective at limiting damage to the eye and any vision loss that may result. For this reason, it is a good idea to apply first aid and seek assessment of the injury as soon as possible. 

If you suspect a severe eye injury has occurred you can:

  • Call an ambulance on 000, or;
  • Attend the emergency department of a hospital as soon as possible.

If an eye injury occurs that seems less serious, you can see an optometrist or general practitioner to have it assessed.

It is important when delivering first aid to a person with an eye injury to:

  • Never directly apply pressure to the eyeball;
  • Never attempt to remove any object embedded in or protruding from the eyeball, and;
  • Ask the person to close their unaffected eye and avoid moving it. This helps protect both the unaffected eye and their injured eye, as both tend to move together.

Optometrist

A health professional trained to detect eye conditions and prescribe glasses.

Prevention

While eye injuries cannot be completely prevented, following general safety precautions in order to protect your eyes, and any safety regulations in your workplace or sport, can help to reduce the risk. This is particularly important if you only have good vision in one eye, as an injury to your good eye can have a much greater impact on your vision.

Measures that can help to prevent eye injury include:

  • Wearing appropriate safety glasses or eye protection when performing potentially hazardous activities;
  • Wearing sunglasses when you are going to be exposed to high levels of sunlight, particularly for long periods of time, or in situations where there are a lot of reflective surfaces;
  • Taking extra care to avoid splashes when handling chemicals;
  • Following your optometrist's or ophthalmologist's instructions with regard to wearing contact lenses;
  • Not wearing contact lenses that have not been specifically prescribed for you;
  • Teaching children to be aware of the risks of eye injuries and to avoid actions such as throwing objects at someone else's face or eyes, and;
  • Coaching and supervising sports to encourage safety. The rules of junior sports may need to be modified to reduce risk.

Ophthalmologist

A doctor who specialises in diagnosing and managing conditions of the eye and visual system.

Optometrist

A health professional trained to detect eye conditions and prescribe glasses.